Severe H1N1 infection in females 'striking': study

Dr. Anand Kumar, intensive care unit attending physician for the Winnipeg Regional Health Authority, looks at the monitor of a ventilator at the St. Boniface Hospital in Winnipeg. (Canadian Press/John Woods)

Many of the Canadians who died or were sent to hospital earlier this year with H1N1 virus were young adults, female and aboriginal, a new study suggests.

The study, published in Monday's online issue of the Journal of the American Medical Association, looked at 168 patients with confirmed or probable swine flu.

Of the group, 24 or 14.3 per cent, died within the first 28 days of becoming critically ill, Dr. Anand Kumar, an intensive care specialist at the Health Sciences Centre and St. Boniface Hospital in Winnipeg and his colleagues found.

"Our data suggest that severe disease and mortality in the current outbreak is concentrated in relatively healthy adolescents and adults between the ages of 10 and 60 years," the study's authors wrote.

The ages in the mortality pattern were similar to that of the 1918 H1N1 Spanish flu pandemic, they said.

Other findings included:

• 32.2 was the average age of patients.
• 67.3 per cent were female.
• 29.8 per cent were children.
• 25.6 per cent were First nations, Inuit, Metis or aboriginal Canadians.
• 81 per cent received mechanical ventilation.
• 12 days was the average length of stay in ICU and on a ventilator.

The most common other illnesses that patients had were a history of lung disease or smoking, obesity, hypertension and diabetes.

Aboriginals 'cause for concern'

"The increased fraction of the aboriginal community presenting with severe 2009 influenza A (H1N1) infection is notable but not unique," the study's authors said, pointing to the three to nine per cent mortality in aboriginal communities from the 1918 Spanish flu pandemic, compared with less than 0.75 per cent in nonaboriginal communities then.

"Although mortality was not substantially greater among aboriginal Canadians in this report, the number of patients with severe disease and knowledge of prior illness patterns in this community is a cause for concern," the researchers said.

The tendency of females to develop severe infection was "striking," and has not been observed in other studies of the H1N1 pandemic, they said.

The reason is unclear, but the role of pregnancy has been noted in previous influenza pandemics. In the latest study, 7.7 per cent of the patients were pregnant.

[SUBHEAD] Mexican patients died waiting for ICU bed

In most infectious diseases such as sepsis and septic shock, it's mostly males that are affected and have a higher mortality, the team said.

It's hoped that describing the risk factors, typical clinical features and response to therapy will help in recognizing, diagnosis and managing H1N1 infections.

The study included cases from most regions of Canada but many were from Manitoba's outbreak, which involved an aboriginal population.

Overall, a second study appearing in the same issue of 58 patients admitted to ICU in Mexico City with swine flu-related disease showed similar findings.

Mexican ICU patients also tended to be relatively healthy adolescents and young adults. An average of 12 days of mechanical ventilation and "rescue therapies" such as specialized ventilation and inhaled nitric oxide, were needed.

The Mexico mortality rate was twice that of Canada's, and four Mexican patients died waiting for ICU beds.

"The investigators from both Mexico and Canada noted that the health care systems struggled to meet the demands created by the increased patient volume, a sobering observation given the absolute number of excess ICU admissions was modest," Dr. Douglas White, and JAMA editor Dr. Derek Angus, both of the University of Pittsburgh School of Medicine, said in a journal editorial.

The editorial authors suggests several ways for hospitals to respond to the unique needs of the sickest H1N1 patients, such as:

• Regionalizing care to preserve resources at other hospitals for other patients.
• Developing telemedicine consultations for doctors in outlying hospitals to check with experts.
• Make temporary staffing changes at hospitals to ensure doctors who are experienced in handling these cases are always present.

Last week, researchers in the U.S., Australia and New Zealand reported similar findings on the ages of the sickest H1N1 patients in those countries during the spring.

Source: CBC News

Blast near Pakistan's Swat valley kills 41

Mon Oct 12, 2009 10:17am EDT

The leader of the attack, a former soldier who deserted in 2004 and joined a militant group based in Punjab province, was the only attacker captured alive but wounded, Abbas said.

The man, identified as Aqeel, also known as Dr Usman, was from Punjab, he said.

Abbas said that while the Taliban and Punjabi militant groups had links there were no militant "safe havens" in Punjab, Pakistan's biggest and economically most important province.

Earlier on Monday, Pakistani Taliban spokesman Azam Tariq claimed responsibility and threatened more attacks.

"It was carried out by our Punjab unit," Tariq said by telephone. "We will take revenge for our martyrs and will carry out more attacks, whether it's the GHQ or something bigger," he said, referring to the army's General Headquarters.

A ground offensive in South Waziristan could be the army's toughest test since the militants turned on the state.

The army has not said when it would begin but Interior Minister Rehman Malik said on the weekend it was "imminent."

The military has been conducting air and artillery strikes for months, while moving troops, blockading the region and trying to win over factions.

Military aircraft attacked in the region on Monday killing up to five militants, an intelligence official said, a day after about 16 militants were killed in air strikes.

"There is no mercy for them because our determination and resolve is to flush them out," Malik told Reuters in an interview in Singapore. "They have no room in Pakistan, I promise you."

About 28,000 troops have been put in place to take on an estimated 10,000 hard-core Taliban, army officials said earlier.

Monday's blast, the fourth big attack in a week, triggered selling on Pakistan's main stock market, which fell 1.3 percent.

"The market witnessed a correction due to security concerns across the country," said Furqan Punjabi, analyst at Topline Securities Ltd.

Source: Reuters

Lobbyists Out in Full Force as Senate Prepares to Vote on Health Care Bill Tuesday

By JAKE TAPPER
Oct. 12, 2009

As the Senate Finance Committee prepares to vote Tuesday on its version of health care legislation, White House officials say they have momentum as the narrative shifts from whether a bill will pass to what it will contain.

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The Senate Finance Committee is set to vote on health care reform legislation.

But, even as conservative commentators admit that health care overhaul will happen, lobbyists are leading a final push to sidetrack the legislation.

A new report by health industry lobbyists at America's Health Insurance Plans, prepared by consulting firm PricewaterhouseCoopers, concludes that health coverage costs for families would increase by 111 percent in the next 10 years under provisions proposed by the Senate Finance Committee. That means costs would jump, on average, to $25,900 for families by 2019, and to $9,700 for individuals.

But some experts say the report is flawed in many ways, pointing out that it does not take into account federal subsidies for lower-income families to help them pay for coverage. The report itself acknowledges that it doesn't account for the advantages the legislation hopes to achieve from an excise tax imposed on employers who offer high-cost insurance plans, saying that although "we expect employers to respond to the tax by restructuring their benefits to avoid it," the report does not factor in those hypothetical responses.

The White House assailed the report as inaccurate and biased.

"This is a self-serving report paid for by opponents of health reform and was prepared by a firm that specializes in tax shelters," said Linda Douglas, spokeswoman for the White House Office of Health Care Reform. "It ignores all cost savings in the bill, such as tax credits, and ignores the conclusion of nonpartisan government analysts, who found that it will cover 94 percent of Americans and help to reduce the deficit."

The bipartisan Congressional Budget Office last week gave the committee's bill something of a green light, saying that the legislation, devised mainly by Chairman Sen. Max Baucus, D-Mont., would cover 29 million uninsured Americans, ultimately achieving 94 percent coverage and costing a total of $829 billion over 10 years. President Barack Obama had set $900 billion as the acceptable threshold for health care legislation costs.

The White House desperately wants to be able to call the bill bipartisan and is doing everything it can to secure the support of Sen. Olympia Snowe, R-Maine, thought to be the only Republican on the Senate Finance Committee who might vote for Baucus' legislation. Having struggled to get any current Republican officials to support Obama's reform efforts, the White House is now touting former GOP officials who are pushing for bipartisan compromise.

Dr. Louis Sullivan, former secretary of the Department of Health and Human Services under President George H.W. Bush, told ABC News that the Senate Finance Committee's bill is more bipartisan, compared to the four other Democratic bills circulating in Congress.

"We need to come together towards the middle and this is what the Baucus bill represents," Sullivan said. "It represents a compromise that has elements that, indeed, I think all individuals, Republicans and Democrats, can support."

Even though he doesn't agree with all the provisions in the bill, Sullivan said it's time for Congress to push health care overhaul and pass a bill.

"We're not going to get a perfect answer," he said. "Our system is too large and too complex to accomplish that in one action, but we need to have a beginning. I'm more concerned about not having the beginning of reform of our health care system. These concerns I have I think can be addressed in due course, but we need to really come together and enact health care reform now."

Source: ABC News